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目的探讨中期因子(midkine,MK)在胃癌组织中表达及其与微血管密度(MVD)和临床病理特征的关系,探讨影响胃癌患者长期生存的预后因素。方法应用免疫组化两步法检测107例胃癌组织中中期因子和CD34的表达,并以31例正常胃黏膜标本作对照。对CD34阳性血管进行MVD计数,并结合临床资料进行统计学分析。结合随访资料,应用Cox比例风险模型对可能影响胃癌预后结果的参数进行分析。结果胃癌组织中的中期因子阳性表达率分别为69.2%,MVD为32.74±6.46;正常胃黏膜组织中期因子0.00%,MVD为14.55±4.07,胃癌组织中中期因子表达率及MVD均明显高于正常胃黏膜组织(均P<0.01)。中期因子表达与胃癌的大小、有无淋巴结转移、浸润深度、TNM分期有关(均P<0.01),而与患者年龄、性别无关。在胃癌组织中中期因子的表达与MVD呈正相关(r=0.592,P<0.01)。MVD与胃癌的大小、浸润深度、有无淋巴结转移、TNM分期有关(均P<0.01)。Cox单因素回归分析表明胃癌的大小、浸润深度、有无淋巴结转移、病理分期、中期因子表达与胃癌的预后有关(P<0.05),而性别、年龄等与预后无关(P>0.05)。但经Cox多因素回归分析,只有肿瘤的病理分期、MK表达具有独立的预后意义(P<0.05)。结论在胃癌组织中,中期因子的过度表达可能在肿瘤的血管生成和进展过程中起着重要作用。MK过表达可作为评估胃癌患者预后的独立指标,从而指导胃癌的治疗。
Objective To investigate the expression of midkine (MK) in gastric carcinoma and its relationship with microvessel density (MVD) and clinicopathological features and to explore the prognostic factors that affect the long-term survival of patients with gastric cancer. Methods The expression of midkine and CD34 in 107 gastric cancer tissues was detected by immunohistochemical two-step method and 31 normal gastric mucosa specimens were used as controls. CD34 positive vessels MVD count, combined with clinical data for statistical analysis. Combined with follow-up data, the Cox proportional hazards model was used to analyze the parameters that may affect the prognosis of gastric cancer. Results The positive expression rates of midkine in gastric cancer tissues were 69.2% and 32.74 ± 6.46, respectively. The mid-term 0.00% and MVD of normal gastric mucosa tissues were 14.55 ± 4.07. The expression rates of mid-term and MVD in gastric cancer tissues were significantly higher than those in normal tissues Gastric mucosal tissue (all P <0.01). The expression of midkine was associated with the size of gastric cancer, lymph node metastasis, depth of invasion and TNM staging (all P <0.01), but not with age and sex. The expression of midkine in gastric cancer tissues was positively correlated with MVD (r = 0.592, P <0.01). MVD and gastric cancer size, depth of invasion, with or without lymph node metastasis, TNM stage (all P <0.01). Cox univariate regression analysis showed that the size of gastric cancer, depth of invasion, lymph node metastasis, pathological stage and midkine were related to the prognosis of gastric cancer (P <0.05), but not gender and age (P> 0.05). However, by Cox regression analysis, only the pathological stage of the tumor and MK expression had independent prognostic significance (P <0.05). Conclusion The overexpression of midkine may play an important role in tumor angiogenesis and progression in gastric cancer. MK overexpression can be used as an independent index to evaluate the prognosis of patients with gastric cancer, which can guide the treatment of gastric cancer.